The final rules were included as part of a joint release late Tuesday from CMS and the Office of the National Coordinator (ONC) for Health Information Technology of regulations related to certification of electronic health record (EHR) systems and rules for Medicare and Medicaid EHR incentive programs.

"We eliminated unnecessary requirements, simplified and increased flexibility for those that remain, and focused on interoperability, information exchange, and patient engagement. By 2018, these rules move us beyond the staged approach of 'Meaningful Use' and focus on broader delivery system reform," Conway said. The release noted that CMS was seeking additional public comments in order to further improve the rules of the program, which incentivizes physicians and hospitals to make "meaningful use" of EHRs.

Among other things, the Stage 3 rules include eight objectives for eligible professionals, down from 20 in Stage 2, according to CMS. And in Stage 3, more than 60% of the proposed Meaningful Use measures require interoperability, up from 33% in Stage 2, the agency noted.

The rules also feature flexible options for measure selection, and they align continuous quality measurement reporting with other CMS quality reporting programs. Stage 3 requirements are optional in 2017, although those providers who choose to start Stage 3 that year will have a 90-day reporting period, CMS said. Stage 3 will become mandatory starting in 2018.

Although CMS touted the regulations as giving providers increased flexibility, that is not how some provider groups saw it. "The decision to ... finalize the program requirements at this time remains difficult to implement," American College of Cardiology President Kim Allan Williams Sr., MD, said in a statement.

"Many of the requirements for Stage 2 proved unattainable. Large numbers of providers either haven't met them or, after trying and failing, have given up. That is why it is vital that CMS consider participation data from the current stage to see what is working and what isn't before outlining an upcoming stage. We cannot establish a long-term health care program that does not take into account what we can feasibly attain in the short-term, transitional period."

The American Osteopathic Association (AOA) also was hoping for a different timeline, Laura Wooster, the association's vice-president of public policy, said in a phone interview. "We had hoped that the timeline for Stage 3 would be more aligned with upcoming Medicaid and CHIP Reauthorization Act (MACRA)," which physicians will need to start adhering to in 2019, she said.

Wooster noted that MACRA didn't yet exist when the timeline for Meaningful Use was first laid out, and allowing for a comment period on the Stage 3 rule -- which is very unusual for a final rule -- might help CMS see the need for a better alignment of the two regulations.

The AOA also is concerned that Meaningful Use overall continues to be an all-or-nothing pass/fail program, she continued. "Physicians put a lot of time and money into getting these systems working, but even if they get really close, they fail at the same level as physicians who opted out and didn't do anything. We think a system that has, maybe, different thresholds of achievement with more responsive penalties and rewards would enable a little more flexibility"

Other organizations were more positive in their response. "We are pleased that CMS and the Office of the National Coordinator listened to the AMA [American Medical Association] and the concerns of physicians in several key areas in the modifications rule," AMA President Steven Stack, MD, said in a statement. "In particular, the agency addressed the delay in issuing the modifications rule by allowing a hardship exemption for physicians who are unable to attest this year, providing needed relief for those uncertain about the 2015 program requirements."

Stack added, however, that "The AMA continues to believe that Stage 3 requires significant changes to ensure successful participation, and improve the usability and interoperability of electronic health record systems. We urge CMS to use the additional public comment period provided for Stage 3 to further improve the program ... We also want to make sure that EHR vendors have the time they need to further test products for interoperability, usability, safety and security."

"The administration has a tin ear," Alexander continued. "We asked: 'Why spend a year modifying rushed up mistakes? Why not spend a year getting it right in the first place?' ... They've missed a golden opportunity to develop bipartisan support in Congress and throughout the country for an electronic health records system that would genuinely help patients. Instead, they've rushed ahead with a rule against the advice of some of the nation's leading medical institutions and physicians."

Alexander noted that Congress will review the final rule carefully "and has the option of fixing it through legislation or overturning it through the Congressional Review Act."

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